Supply-duration traps to confirm in your VSDH agreement
Trap one — titration waste: a patient who titrates up mid-cycle may not finish a multi-month vial at the starting concentration. Compare per-dose cost at each titration step, not just the headline multi-month wholesale.
Trap two — shipping multiplication: if VSDH bills shipping per shipment, monthly orders multiply shipping cost versus one multi-month shipment — but multi-month ties up cash in inventory. Confirm shipping rules for both patterns.
Trap three — revenue share on larger orders: if revenue share applies to pharmacy order totals, a multi-month vial may trigger a higher absolute share payment even when per-dose wholesale improves. Model all-in economics, not wholesale alone.
Ask VSDH for written per-dose cost at each supply duration you consider, across your titration ladder, with shipping and revenue share included.